House Appropriations Committee examines $19B Human Services budget

The proposal includes a $2.7B increase over the 2021-22 budget

By: - April 11, 2023 5:45 pm

Pa. Human Services Secretary-designee Valerie Arkoosh (Photo courtesy of Gov.-elect Josh Shapiro Transition Team).

Acting Human Services Secretary Valerie Arkoosh appeared before the Pennsylvania House Appropriations Committee on Tuesday to field lawmakers’ questions on issues ranging from mental health to dental care as they parsed the state’s largest departmental budget.

The $19 billion spending proposal for the Department of Human Services includes a $2.7 billion increase over the 2021-22 budget. 

Arkoosh said the budget proposal presents a responsible use of taxpayer money while sustaining and expanding the services that the department provides to about 3.6 million Pennsylvania residents. 

It includes $66.7 million to support the state’s Child Care Works program to subsidize child care for low-income working parents and $4 million to provide child care for parents seeking a degree or certification. 

Another $16 million investment would expand nutritional aid for seniors and people with disabilities by 50% as federal pandemic food assistance goes away this year. 

The proposal would make investments in mental health services including $20 million in county mental health systems, $4 million for community-based mental health interventions for people involved in the criminal justice system, and $5 million to support the state’s 13 suicide and crisis 988 lifelines.

Arkoosh, a physician and former Montgomery County commissioner, said that she was familiar with the struggles county mental health and corrections officials face in providing mental health services. 

“The large number of individuals that are in our correctional facilities with behavioral health challenges is really tough and and while they might be getting some treatment there, they’re certainly not getting optimal treatment in that setting,” Arkoosh said.

The budget’s funding for county mental health agencies would allow them to coordinate community-based services to prevent people from becoming involved in the justice system and create more capacity to treat people upon their release from correctional facilities. 

Rep. Morgan Cephas, D-Philadelphia, noted that juvenile justice has been a challenging area in the state’s largest city and across Pennsylvania.

“The Juvenile Justice Center has been in the news regarding significant overcrowding issues, which has resulted in altercations young people being forced to live in inhumane conditions and quite frankly, putting many of our staff that are on the ground in jeopardy for their safety,” Cephas said. 

Arkoosh said that while the state has reduced the number of justice-involved youth by 40% over the last five years, that led some providers to leave the area. Combined with pandemic-related challenges and staffing shortages, the department has “overshot” in terms of reducing the number of available beds. 

The department has expanded the number of beds available in its Youth Development Centers by 42, is working with contractors to provide additional beds, recently opened a secure treatment facility in Luzerne County and is exploring another new facility elsewhere in the state. 

Several members of the appropriations committee asked what the department does to guard against Medicaid fraud. Rep. Clint Owlett, R-Tioga, noted it had been estimated at $3 billion in 2020.

Arkoosh said the department’s program integrity office achieved $400 million in cost savings through recoveries and avoiding improper payments in fiscal year 2021. 

“We are constantly working to update this program. We are transitioning to a modernized fraud, waste and abuse detection system that will be designed to enhance our ability to protect federal and state taxpayer dollars,” Arkoosh said, noting the new system will be fully operational by June. 

The agency’s budget secretary, Gloria Gilligan, told lawmakers that  the state’s payment error report for 2022 said Pennsylvania had a 2.5% error rate in Medical Assistance claims and about 5% for the state Children’s Health Insurance Program. The national average is nearly 27%, Gillian said. 

Arkoosh said the department also checks 12 databases ranging from death records to lottery winnings to safeguard against fraud. 

Rep. John Lawrence, R-Chester, noted an 8% increase in Medicaid dental fees and asked why dental services were singled out. He said that reimbursements for other services, such as chiropractic treatment, remain so low that, while they’re covered, Medicaid recipients have trouble finding providers who will see them.

“Everybody in this room appreciates the importance of dental care, but the rest of medical care across the board is important too,” Lawrence said.

Arkoosh said Pennsylvania’s state-funded dental service is extremely limited. But before 2011, it was fully funded. 

“There’s been an attempt to bring back at least the most basic level of dental service and make sure it’s funded in such a way that [Medical Assistance] recipients can receive that critical care,” she said.

Rep. Emily Kinkead, D-Allegheny, noted that the number of dentists in Pennsylvania has declined 7% since 2001, and that providers in cities and suburbs outnumber rural dentists 15-1. 

Pennsylvania’s Medicaid reimbursement rate is 59% compared to 87% in West Virginia, she said.

Kinkead added that a dentist in her district shared voicemails from Medicare patients who were unable to find treatment for tooth pain for months. 

“The anguish and the pain that you can hear and their voices … is just absolutely tragic,” Kinkead said.

“We have effectively made teeth luxury bones. And so I appreciate that the governor has set aside this 8% increase,” she said.

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Peter Hall
Peter Hall

Peter Hall has been a journalist in Pennsylvania and New Jersey for more than 20 years, most recently covering criminal justice and legal affairs for The Morning Call in Allentown. His career at local newspapers and legal business publications has taken him from school board meetings to the Pennsylvania Supreme Court and many points of interest between. He earned a degree in journalism from Susquehanna University.